Get Away to Sunny Florida in January for NPI Education at the State College of Florida (Jan. 18-19, 2013)! Get early bird pricing by Dec 18th! This two- day onsite workshop developed by the National Posture Institute (NPI) teaches personal trainers/group instructors (Aerobic/Strength/TRX/Pilates/Yoga etc…) and allied health/medical professionals to assess and educate their clients/patients in all areas of posture and body alignment. Learn More here: National Posture Institute Florida CEC Posture Workshop

National Posture Institute Research Review-Multivitamin use among middle-aged, older men results in modest reduction in cancer. In a randomized trial that included nearly 15,000 male physicians, long-term daily multivitamin use resulted in a modest but statistically significant reduction in cancer after more than a decade of treatment and follow-up, according to a study appearing in JAMA. The study is being published early online to coincide with its presentation at the Annual American Association for Cancer Research Frontiers in Cancer Prevention Research meeting.

“Multivitamins are the most common dietary supplement, regularly taken by at least one-third of U.S. adults. The traditional role of a daily multivitamin is to prevent nutritional deficiency. The combination of essential vitamins and minerals contained in multivitamins may mirror healthier dietary patterns such as fruit and vegetable intake, which have been modestly and inversely associated with cancer risk in some, but not all, epidemiologic studies. Observational studies of long-term multivitamin use and cancer end points have been inconsistent. To date, large-scale randomized trials testing single or small numbers of higher-dose individual vitamins and minerals for cancer have generally found a lack of effect,” according to background information in the article. “Despite the lack of definitive trial data regarding the benefits of multivitamins in the prevention of chronic disease, including cancer, many men and women take them for precisely this reason.”

J. Michael Gaziano, M.D., M.P.H., of Brigham and Women’s Hospital and Harvard Medical School, Boston, (and also Contributing Editor, JAMA), and colleagues analyzed data from the Physicians’ Health Study (PHS) II, the only large-scale, randomized, double-blind, placebo-controlled trial testing the long-term effects of a common multivitamin in the prevention of chronic disease. The trial includes 14,641 male U.S. physicians, initially age 50 years or older, including 1,312 men with a history of cancer at randomization, who were enrolled in a multivitamin study that began in 1997 with treatment and follow-up through June 1, 2011. Participants received a daily multivitamin or equivalent placebo. The primary measured outcome for the study was total cancer (excluding nonmelanoma skin cancer), with prostate, colorectal, and other site-specific cancers among the secondary end points.

PHS II participants were followed for an average of 11.2 years. During multivitamin treatment, there were 2,669 confirmed cases of cancer, including 1,373 cases of prostate cancer and 210 cases of colorectal cancer, with some men experiencing multiple events. A total of 2,757 (18.8 percent) men died during follow-up, including 859 (5.9 percent) due to cancer. Analysis of the data indicated that men taking a multivitamin had a modest 8 percent reduction in total cancer incidence. Men taking a multivitamin had a similar reduction in total epithelial cell cancer. Approximately half of all incident cancers were prostate cancer, many of which were early stage. The researchers found no effect of a multivitamin on prostate cancer, whereas a multivitamin significantly reduced the risk of total cancer excluding prostate cancer. There were no statistically significant reductions in individual site-specific cancers, including colorectal, lung, and bladder cancer, or in cancer mortality.

Daily multivitamin use was also associated with was a reduction in total cancer among the 1,312 men with a baseline history of cancer, but this result did not significantly differ from that observed among 13,329 men initially without cancer.

The researchers note that total cancer rates in their trial were likely influenced by the increased surveillance for prostate-specific antigen (PSA) and subsequent diagnoses of prostate cancer during PHS II follow-up starting in the late 1990s. “Approximately half of all confirmed cancers in PHS II were prostate cancer, of which the vast majority were earlier stage, lower grade prostate cancer with high survival rates. The significant reduction in total cancer minus prostate cancer suggests that daily multivitamin use may have a greater benefit on more clinically relevant cancer diagnoses.”

The authors add that although numerous individual vitamins and minerals contained in the PHS II multivitamin study have postulated chemopreventive roles, it is difficult to definitively identify any single mechanism of effect through which individual or multiple components of their tested multivitamin may have reduced cancer risk. “The reduction in total cancer risk in PHS II argues that the broader combination of low-dose vitamins and minerals contained in the PHS II multivitamin, rather than an emphasis on previously tested high-dose vitamins and mineral trials, may be paramount for cancer prevention. … The role of a food-focused cancer prevention strategy such as targeted fruit and vegetable intake remains promising but unproven given the inconsistent epidemiologic evidence and lack of definitive trial data.”

“Although the main reason to take multivitamins is to prevent nutritional deficiency, these data provide support for the potential use of multivitamin supplements in the prevention of cancer in middle-aged and older men,” the researchers conclude.

The National Posture Institute's (NPI) one-day workshop teaches personal trainers, all group exercise instructors (Aerobic/Strength/TRX/Pilates/Yoga etc...), and allied health/medical professionals to assess, correct, and educate their clients in all areas of posture and body alignment.

Doing physical exercise at different intensities is a way of controlling blood pressure

A research team from the Faculty of Physical Activity Sciences and Sports at the University of the Basque Country (UPV/EHU) has published the results of research undertaken in 2010 which highlights the importance of doing physical exercise at different intensities as a way of controlling blood pressure. Thus, amongst different groups analysed for the research over a period of eight weeks, the group subjected to supervised physical exercise at different intensities was that which achieved greater benefits for levels of blood pressure and physiological parameters.

The research, led by Dr Sara Maldonado-Martín of the Physical Education and Sports Department at the UPV/EHU, aims to provide continuity to that first research work by means of new investigations every year which are designed to more precisely identify the benefits of exercise for high blood pressure patients. Thus, for the new round of research prepared for this year, an increase from eight to sixteen weeks in the period of monitored training is anticipated.

With this widening of the research, the aim is to find out what influence greater periods of research have on the results; and, moreover, to ascertain if it is sufficient with less volume of training and obtain similar improvements. For this final aim, it is expected to include a new study group that will alternate moderate and intense sessions of exercise, but with sessions having less duration than the rest of the groups.

In this way, the study will randomly distribute the participants thereof in four groups:

1. A non-supervised group with general recommendations for healthy lifestyle.

2. A supervised group of programmed continuous physical exercise of moderate intensity.

3. A supervised group of physical exercise programmed with different intensities (intervaled), alternating moderate and intense sessions and with a volume of minutes less than the continuous group.

4. A supervised group of physical exercise programmed with different intensities (intervaled), alternating moderate and intense sessions and with the same volume of minutes than the continuous group.

Participation in the research

The UPV/EHU research team, at the same time as disseminating the benefits involved in undertaking exercise for controlling blood pressure, would ask those members of the public in the Basque Country who suffer from high blood pressure and who are interested in taking part in this new research to contact the lead researcher of the project: Sara Maldonado-Martín (945013534 /sara.maldonado@ehu.es). It is important to remember that the more participants taking part in the research, the more precise and reliable will be the results obtained on those suffering from high blood pressure.

Moreover, for each one of the participants in the research on those suffering from high blood pressure, taking part in the study will enable them to have more precise information on their general physical condition, the personal progress in their blood pressure levels over the duration of the research, and the changes that have taken place by the end. In short, the study will enable better control of behaviour in different situations of high blood pressure levels, the medical team supervising the personalised data.

Evaluation trials

All participants for the groups supervised will attend the centre where the physical exercise is to carried out; a total of 32 sessions involving 2 sessions a week over a total of 16 weeks, and supervised by students from the Faculty of Physical Activity Sciences and Sports.

Those with high blood pressure participating in the research have to undergo preliminary stress tests at the Faculty’s Physiology Laboratory. Then, over sixteen subsequent weeks, the participants in the supervised exercise groups mainly do the treadmill belt and static bicycle in exercises the intensity of which is designed individually depending on the results of the stress tests previously undertaken. After this period is finished, the initial tests are repeated in order to compare both, for blood pressure and for other physiological and anthropometric variables.

The principal trials to be undertaken are:

1. By means of a portable device, on-the-spot monitoring of the mean arterial blood pressure (MAP) is undertaken at the beginning and end of the programme, taking various measurements over a 24-hour period. The test enables confirming the diagnosis of high blood pressure or if the participant is only responding to this condition due to a transitory emotional state during certain times of the day.

2. Stress tests with a rowing machine (ergometer) and static bicycle with measurement of the variables in rest mode, sub-maximum mode and at peak values, in order to evaluate the functional cardiorespiratory capacity and blood pressure.

National Posture Institute Research Review-Physical activity shown to help young and elderly alike with lower-leg coordination.

An Indiana University study that examined the effect of age and physical activity on lower leg muscle reflexes and coordination concluded that participation in physical activity was beneficial for lower leg muscle coordination across both sides of the body in both young and older study participants. Lower limb muscle communication is essential for everyday tasks, such as walking, balancing, and climbing stairs.

"The results of this study suggest that participation in physical activity contributes to greater crossed-spinal reflex stability in both young and elderly subjects," said exercise scientist Rachel Ryder, a visiting research associate in the IU School of Public Health-Bloomington. "In other words, the two lower legs maintain stable muscular communication patterns, which could contribute to better coordination of muscles across the right and left side of the body. The lack of this coordination or stability could exacerbate fall risk in older, sedentary subjects."

Ryder's study, discussed at the Neuroscience 2012 scientific meeting in New Orleans on Wednesday, involved 28 healthy men and women who were sorted by age into two groups: 14 subjects in a group of people 20- to 25-years old; the rest were over 65. Based on the International Physical Activity Questionnaire, the two groups were divided further into physically active or sedentary.

The researchers tested reflexes by alternately stimulating nerves in each leg with an electrical current while study participants rested in a prone position.

"Participation in physical activity could play an important role in maintaining the muscle reflex system in the lower limbs and assist in coordination throughout life," Ryder said. "This is particularly important in older adults. While voluntary movement has a large role to play in fall-prevention, the motor system's 'first line of defense' against a slip or trip is the reflex system. The muscle reflexes are capable of generating a motor response in under 50 milliseconds, allowing the reflex system to quickly correct for a sudden change in body position, or at the least, reduce the impact of the fall."

NPI NEWS STORY: Lower extremity pain linked to poor physical and mental health in overweight kids. Pain in the lower extremities – feet, ankles, knees and hips – contributes to both poor physical function and a reduced quality of life in obese children, according to a new study by Dr. Sharon Bout-Tabaku and colleagues, from Nationwide Children’s Hospital and The Ohio State University in the US. Their work shows that obese children with lower extremity pain have worse physical function and poorer psychological health than obese children without lower extremity pain. Their findings appear online in Clinical Orthopaedics and Related Research®, published by Springer.

Obese children show diminished function, reduced psychosocial health (emotional, social and school functioning), and lower physical fitness compared with healthy weight peers. For these children, pain in the lower extremities is more common than pain in the upper extremities and back. However, it remains unclear whether pain interferes with physical fitness or physical activity levels in obese children.

Although poor physical fitness was not related to having pain, children who reported lower extremity pain scored lower on physical function and psychosocial health than those who felt no pain. In addition, as the severity of obesity increased, there was a progressive decline in physical function, psychosocial health and fitness scores among those who reported lower extremity pain.

National Posture Institute News Story-How to Assess Work-Related Risk of Musculoskeletal Injuries. Recommendations for Ergonomic Practitioners Published in Work: A Journal of Prevention, Assessment, and Rehabilitation.

A new paper by Thomas J. Albin, PE, CPE, of High Plains Engineering Services in Minneapolis, Minnesota, USA, confirms that observational assessment tools, often called checklists, used to assess risk factors such as wrist extension and motion repetition, can be valid tools in identifying work-related risk factors for musculoskeletal injuries. Published in Work: A Journal of Prevention, Assessment, and Rehabilitation, Albin presents a comprehensive, multi-step yet simple approach for improving the use and effectiveness of checklists.

Previous scholarship regarding the reliability and validity of checklists is limited and sometimes contradictory. Some critics suggest that checklists may overestimate the presence of risk factors and others have questioned their reliability. In this paper, Albin presents a well-founded approach that an ergonomics practitioner can use to dynamically measure the reliability and validity of checklists that he or she uses in order to be sure that they are effective tools.

Traditionally the reliability of a checklist is based on correlating two ratings of the same job performed by a single evaluator or by assessing the agreement of the ratings given to a job by a group of evaluators. Albin argues that alternate methods of assessing consistency are equally appropriate, for example, the use statistical process control tools such as control charts.

Albin also questions how well un-validated checklists serve as a tool to put resources against an at-risk job. “If you have to persuade a manager to release resources to remediate a high-risk job based on checklist findings, what assurance can you give that you are committing limited resources to the appropriate job or jobs?” Albin said.

Albin recommends a thorough yet concise approach for assessing a checklist’s predictive quality. Using the basic information gathered from analyzing jobs with a checklist, the practitioner can construct a 2 x 2 statistical table that serves as the basis for probability calculations, which ultimately yield the probability that at-risk jobs are correctly identified. He also discusses testing the significance of differences between alternate forms of a checklist, fine-tuning checklists, generalizing findings to new situations, and assessing the relative importance of risk factors to the identification of the problem job.

2. NPI Affiliate Program- Providing Health Clubs/Allied Health-Medical Facilities successful business solutions through the integration of NPI's certificate and Posture Assessment Program to retain and build a large client/patient/membership base as an NPI Affiliate.

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